District Consumer Forum, Bokaro.

Complaint Case No. 97 of 2008



Smt. Latika Devi w/o late Gopal Digar

R/o Village- Jainamore, Das Tola, P.O. Jainamore,

P.S.- Jaridih, Dist.- Bokaro.

Versus

1. M.s Bajaj Allianz General Insurance Co. Ltd.

Sector-IV, B.S.City, Bokaro Branch, Bokaro.

2. Secretary,

Bokaro Steel Samuhik Durghatna Bima Samity

Room No. 82, Old Admn. Building, Bokaro Steel City, Bokaro.

Before-

S.M.Alam, President

Vijay Bahadur Singh, Member
Shabnam Praveen, Member



Date of Judgment-: 13 March, 2009

Date of case filing-: 08 December, 2008.



-: Judgment:-

The complainant has filed this case against the opposite party for payment of Rs. 250000/- as insurance coverage along with 12 % interest from the date of repudiation till date of actual payment and payment of Rs. 25000/- as compensation.

2 The complainant’s case in brief is that her husband was employed in Medical Department in Bokaro Steel Plant having staff no. 627797. The complainant’s husband was covered under group insurance scheme of the opposite parties for Rs. 250000/-, the policy no. being OG-07-G2401-9902-00000032 OPA. On 01.07.2006 the petitioner husband met with an accident while he was going to Dundibag Bazar on his Motor Cycle. He was seriously injured and was treated in BGH on 01.07.06 to 14.07.2006. Unfortunately he died on 14.07.2006 due to head injury arising out of his Road accident on 01.07.2006. A U D case no. 21/2006 was registered with Sector 12 Police Station and Post Mortem examination of dead body was done.

3 The further case of the complainant is that she put death claim to the opposite parties for payment which was repudiated by the insurance co. vide its letter no. 11.12.2006 on the ground that the complainant’s husband met with an accident while he was driving his motorcycle in an intoxicated conditions which resulted in his death.

4 Upon issuance of notice, the opposite party no.1 neither appeared in the Court nor filed any written statement. Opposite party no.2, though appeared but failed to any written statement in spite of several adjournments. Hence the case proceeded accordingly.

5 Heard the complainant. The opposite parties failed to argue the case. While going through the entire case records and documents filed in the case, it is observed that the group accidental insurance coverage of the complainant’s husband, his death on 14.07.2006 due to his road accident on 01.07.2006 are admitted facts. As per the copy of the death certificate issued by BGH the death of the complainant’s husband is due to severe head injury with ARDS. As per the FRT the death of the complainant’s husband is due to severe injury sustained on account of his fall from the Motor Cycle. As per the Post Mortem Report the cause of death is due to severe head injury leading to cardioresperatory failure. Copies of all the above reports have been placed in the case records. It is found that there is nothing on records to establish that the complainant’s husband was under the influence of liquor or drugs at the time of his accident leading to his death. In view of the above we conclude that the repudiation of the complainant’s claim by the insurance co. is not at all justified. We, therefore, hold that the opposite party No.1 has been negligent and deficient in service towards the complainant while repudiating her death claim. Opposite party No.1 is hence held liable to pay the death claim to the complainant.

6 Under the facts and circumstances of the case the opposite party No. 1 M/s Bajaj Allianz General Insurance Co. Ltd. B.S.City Bokaro branch, Sector-IV, Bokaro is directed to pay Rs. 250000/-(Rupees two lacs fifty thousand) only as death claim along with interest @ 9% per annum on the above amount with effect from 08.12.2008 till payment to the complainant within 30 days from the date of this order. The above opposite party is further directed to pay compensation of Rs. 2000/(Rupees two thousand) only within 30 days from the date of this order.